Organization
DOMINION HEALTH MEDICAL ASSOC
Active
Other names
Sentora Southern Virginia Ear ,Nose,Throat
Organization subpart
No
Provider details
NPI number
Authorized official
CECIL F HAZELWOOD (MANAGER/SDHG)
(434) 517-3515
Entity
Organization
Contact information
Practice address
2232 WILBORN AVE, SUITE F, SOUTH BOSTON, VA 24592
(434) 517-8095
(434) 517-3887
Mailing address
P.O.BOX 860, SOUTH BOSTON, VA 24592
(434) 517-3513
(434) 517-3887
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101251391
VIRGINIA LICENSE
VA
Enumeration date
08/27/2012
Last updated
02/10/2015
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